Low profile plate

ABSTRACT

The present application generally relates to orthopedic systems, and in particular, to systems including independent plates and spacers. A plating system can include a spacer and a plate that is independent from the spacer. A number of locking mechanisms can be provided to secure the plate to the spacer. In some cases, the spacer includes a pair of notches that extend on an outer surface of the spacer. The plate can include a pair of lateral extensions that can engage the notches to secure the plate to the spacer. In other cases, the spacer includes an opening including a pair of inlets. The plate can include an enclosed posterior extension that can be received in the pair of inlets to secure the plate to the spacer.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation-in-part application of U.S.Ser. No. 14/320,200, filed Jun. 30, 2014, which is acontinuation-in-part application of U.S. Ser. No. 14/190,948, filed Feb.26, 2014, which is a continuation-in-part application of (i) U.S. Ser.No. 13/785,434, filed Mar. 5, 2013 and of (ii) U.S. Ser. No. 14/085,318,filed Nov. 20, 2013, which is a continuation-in-part application of U.S.patent application Ser. No. 13/785,856, filed Mar. 5, 2013, which is acontinuation-in-part of U.S. patent application Ser. No. 13/559,917,filed Jul. 27, 2012, which is a continuation-in-part of Ser. No.13/267,119, filed Oct. 6, 2011, which claims priority to U.S.Provisional Application 61/535,726, filed on Sep. 16, 2011, the entirecontents of which are incorporated by reference.

FIELD OF THE INVENTION

The present application is generally directed to orthopedic systems, andin particular, to systems including plates and spacers.

BACKGROUND

Spinal discs and/or vertebral bodies of a spine can be displaced ordamaged due to trauma, disease, degenerative defects, or wear over anextended period of time. One result of this displacement or damage maybe chronic back pain. In some cases, to alleviate back pain, the disccan be removed and replaced with an implant, such as a spacer, thatpromotes fusion. In addition to providing one or more spacers, a platingsystem can be used to further stabilize the spine during the fusionprocess. Such a plating system can include one or more plates and screwsfor aligning and holding vertebrae in a fixed position with respect toone another.

Accordingly, there is a need for improved systems involving platingsystems and spacers for spinal fusion and stabilization.

SUMMARY OF THE INVENTION

Various systems, devices and methods related to plating systems areprovided. In some embodiments, a spinal system comprises a spacer forinserting into an intervertebral space and a plate configured to abutthe spacer. The spacer can include an upper surface, a lower surface andan opening that extends between the upper surface to the lower surface,wherein the spacer further includes a tapered leading end. The plate forabutting the spacer can include a plate body, a first opening formed inthe plate body for receiving a first bone screw, a second opening formedin the plate body for receiving a second bone screw, a set screw, and apair of extensions that extend from the plate body that are configuredto engage the spacer. The first opening can angled in an upwarddirection, while the second opening can be angled in a downwarddirection. The set screw can be configured to prevent back-out of boththe first and the second bone screws, wherein the set screw has a firstposition whereby the first and second bone screws can be inserted pastthe set screw and into the first and second openings and a secondposition following rotation of the set screw whereby the first andsecond bone screws are prevented from backing out by the set screw. Afirst bone screw is provided for inserting into the first opening in theplate body, wherein the first bone screw is configured to be insertedinto a first vertebral body. A second bone screw is provided forinserting into the second opening in the plate body, wherein the secondbone screw is configured to be inserted into a second vertebral bodydifferent from the vertebral body.

In other embodiments, a spinal system comprises a spacer for insertinginto an intervertebral space and a plate configured to abut the spacer.The spacer can include an upper surface, a lower surface and an openingthat extends between the upper surface to the lower surface, wherein thespacer further includes a concave leading end. The plate for abuttingthe spacer can include a plate body, a first opening formed in the platebody for receiving a first bone screw, a second opening formed in theplate body for receiving a second bone screw, a set screw, and a pair ofextensions that extend from the plate body that are configured to engagethe spacer. The first opening can angled in an upward direction, whilethe second opening can be angled in a downward direction. The set screwcan be configured to prevent back-out of at least one of the first andthe second bone screws, wherein the set screw has a first positionwhereby at least one of the first and second bone screws can be insertedpast the set screw and into at least one of the first and secondopenings and a second position following rotation of the set screwwhereby at least one of the first and second bone screws are preventedfrom backing out by the set screw. Each of the pair of extensions caninclude a window that extends along a length of the extension. A firstbone screw is provided for inserting into the first opening in the platebody, wherein the first bone screw is configured to be inserted into afirst vertebral body. A second bone screw is provided for inserting intothe second opening in the plate body, wherein the second bone screw isconfigured to be inserted into a second vertebral body different fromthe vertebral body.

In some embodiments, a spinal system comprises a spacer for insertinginto an intervertebral space and a plate configured to abut the spacer.The spacer can include an upper surface, a lower surface and an openingthat extends between the upper surface to the lower surface. The platefor abutting the spacer can include a plate body, a first opening formedin the plate body for receiving a first bone screw, a second openingformed in the plate body for receiving a second bone screw, a set screw,and a pair of extensions that extend from the plate body that areconfigured to engage the spacer. The first opening can angled in anupward direction, while the second opening can be angled in a downwarddirection. The set screw can be configured to prevent back-out of atleast one of the first and the second bone screws, wherein the set screwhas a first position whereby at least one of the first and second bonescrews can be inserted past the set screw and into at least one of thefirst and second openings and a second position following rotation ofthe set screw whereby at least one of the first and second bone screwsare prevented from backing out by the set screw. Each of the pair ofextensions can include a window that extends along a length of theextension. A first bone screw is provided for inserting into the firstopening in the plate body, wherein the first bone screw is configured tobe inserted into a first vertebral body. A second bone screw is providedtor inserting into the second opening in the plate body, wherein thesecond bone screw is configured to be inserted into a second vertebralbody different from the vertebral body. The spacer and the plate areindependent from one another such that the spacer can be inserted into adesired spinal location prior to abutting the spacer with the plate.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-1D illustrate different views of a low profile plate attachedto a spacer according to some embodiments.

FIGS. 2A-2D illustrate different views of the low profile plate shown inFIGS. 1A-1D.

FIGS. 3A-3D illustrate different views of a PEEK spacer to be used withthe low profile plate shown in FIGS. 2A-2D.

FIGS. 4A-4D illustrate different views of an allograft spacer to be usedwith the low profile plate shown in FIGS. 2A-2D.

FIGS. 5A-5D illustrate different views of a second alternativeembodiment of a low profile plate attached to a spacer according to someembodiments.

FIGS. 6A-6D illustrate different views of the low profile plate shown inFIGS. 5A-5D.

FIGS. 7A-7D illustrate different views of a PEEK spacer to be used withthe low profile plate in FIGS. 6A-6D.

FIGS. 8A-8D illustrate different views of an allograft spacer to be usedwith the low profile plate in FIGS. 6A-6D.

FIGS. 9A-9D illustrate different views of a third alternative embodimentof a low profile plate attached to a spacer according to someembodiments.

FIGS. 10A-10D illustrate different views of the low profile plate shownin FIGS. 9A-9D.

FIGS. 11A-11D illustrate different views of a fourth alternativeembodiment of a low profile plate attached to a spacer according to someembodiments.

FIGS. 12A-12D illustrate different views of the low profile plate shownin FIGS. 11A-11D.

FIGS. 13A-13D illustrate different views of a multi-piece allograftspacer to be used with the low profile plates discussed above accordingto some embodiments.

FIGS. 14A-14D illustrate different views of an alternative multi-pieceallograft spacer to be used with the lower profile plates discussedabove according to some embodiments.

FIGS. 15A-15D illustrate different views of an alternative low profileplate attached to a spacer according to some embodiments.

FIGS. 16A-16D illustrate different views of a low profile plate shown inFIGS. 15A-15D.

FIGS. 17A-17C illustrate different views of a spacer shown in FIGS.15A-15D.

FIGS. 18A-18D illustrate different views of another alternative lowprofile plate attached to a spacer according to some embodiments.

FIG. 19 illustrates a lordotic version of the low profile plate andspacer shown in FIGS. 18A-18D.

FIGS. 20A-20D illustrate different views of another alternative lowprofile plate attached to multiple spacers according to someembodiments.

FIGS. 21A and 21B illustrate different views of another alternative lowprofile plate attached to multiple spacers according to someembodiments.

FIG. 22 illustrates another alternative low profile plate attached tomultiple spacers according to some embodiments.

FIG. 23 illustrates another alternative low profile plate attached tomultiple spacers according to some embodiments.

FIGS. 24A-24C illustrate another alternative low profile plate attachedto a multi-piece spacer having three pieces according to someembodiments.

FIGS. 25A and 25B illustrate another alternative low profile plateattached to a multi-piece spacer having a metal insert according to someembodiments.

FIGS. 26A-26D illustrate another alternative plate having raised andlowered screw openings in attachment with a spacer according to someembodiments.

FIGS. 27A-27D illustrate another alternative plate having raised andlowered screw openings in attachment with a spacer according to someembodiments.

FIG. 28 illustrates the plate and spacer in FIGS. 26A-26D in use withina vertebral space.

FIGS. 29A-29C illustrate the plate in FIGS. 26A-26D.

FIG. 30 illustrates one example of an allograft spacer that can be usedwith the plate in FIGS. 26A-26D.

FIG. 31 illustrates one example of a PEEK spacer that can be used withthe plate in FIGS. 26A-26D.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

The present application is generally directed to orthopedic systems, andin particular, to systems including plates and spacers.

The present application discloses orthopedic plating systems that can beused in spinal surgeries, such as spinal fusions. The plating systemsdisclosed herein include a plate and a spacer that are independent fromone another. In some cases, the plate and the spacer can be pre-attachedto one another before positioning them in a desired location of thespine. In other cases, the spacer can first be inserted into a desiredlocation of the spine, and then the plate can be inserted thereafter.Advantageously, the plating systems disclosed herein are of low-profile.For example, they can provide a very small, anterior footprint cervicalplate solution for fusion procedures. One skilled in the art willappreciate that while the plating systems can be used with cervicalprocedures, the plating systems are not limited to such areas, and canbe used with other regions of the spine.

FIGS. 1A-1D illustrate different views of a plating system comprising alow profile plate attached to a spacer according to some embodiments.The plating system 5 includes a spacer 10 attached to a low-profileplate 50. Advantageously, the plating system 5 can be inserted throughan anterior approach into a spine, and can desirably provide a smallanterior footprint.

The spacer 10 is configured to have an upper surface 12, a lower surface14, and a leading end 22. In some embodiments, the upper surface 12and/or lower surface 14 includes texturing 16, such as teeth, ribs,ripples, etc. to assist in providing frictional contact with adjacentvertebral bodies. In some embodiments, the leading end 22 of the spacer10 can be slightly tapered, as shown in FIG. 1A. With the taper, theleading end 22 can serve as a distraction surface that helps the spacerto be inserted into an intervertebral space. As shown in FIG., 1B, theleading end 22 can be concave, though in other embodiments, the leadingend 22 can be straight or convex.

The spacer 10 can be substantially C-shaped (as shown in FIG. 3B),whereby it includes two side arms 13 that surround an inner opening 20.Adjacent the side arms 13 is a convex wall 19. In some embodiments, theconvex wall 19 is substantially parallel to the concave surface of theleading end 22. The opening 20, which is configured to receive naturalor synthetic graft material therein to assist in a fusion procedure, hasan open side that is opposite convex wall 19, thereby giving the spacer10 its C-shape.

The spacer 10 has a number of unique features that accommodate theattachment of a plate 50 thereto. Each of the side arms 13 of the spacer10 includes a notch 17 (shown in FIG. 3B) for receiving a correspondingprotrusion 71 of a lateral arm or extension 70 of the plate 50, therebyadvantageously forming a first locking mechanism between the spacer 10and the plate 50. In addition, in some embodiments, each of the sidearms 13 of the spacer 10 can also include a hump region 26 (shown inFIG. 3B) that can extend in part into a window 72 of an attached plate50 (shown in FIG. 2A), thereby advantageously providing a second lockingmechanism between the spacer 10 and the plate 50. Advantageously, byproviding secure first and second locking mechanisms between the spacer10 and the plate 50, the plate and spacer will be kept securely togetherduring any type of impaction of the plating system within the body.Furthermore, each of the side arms 13 of the spacer 10 can include acut-away portion or chamfer 18, 19 (shown in FIG. 3C) to advantageouslyaccommodate screws which pass through the plate. In embodiments thatinvolve a pair of screws through the plate 50—one of which passes in anupward direction, and the other of which passes in a downwarddirection—one side arm 13 of the spacer 10 will include an upper chamfer18 formed on an upper surface to accommodate the upwardly directedscrew, while the second side arm 13 of the spacer wilt include a lowerchamfer 19 formed on a lower surface to accommodate the downwardlydirected screw.

The spacer 10 can be formed of any material. In some embodiments, thespacer 10 is formed of a polymer, such as PEEK, as shown in FIG. 3A. Insome embodiments, the spacer 10 is formed of allograft bone, as shown inFIG. 4A. In some instances, to form an allograft implant, allograft bonemay be cut or shaved from a desired bone member. The cut allograft bonewill then be assembled together, using an adhesive or mechanicalfastener (e.g., bone pins). Accordingly, in some embodiments, anallograft spacer 10 is formed of two, three, four or more layers thatare assembled together, such as by one or more bone pins. One particularadvantage of the invention is that the plate 50 can work with a varietyof different spacers 10, as the plate 50 is independently removable fromand attachable to the spacer 10. Regardless of whether a surgeon choosesto implant an allograft spacer or PEEK spacer 10 into an intervertebralspace, the surgeon can simply attach the low-profile plate 50 to thespacer 10 following implantation into the intervertebral space.

The plate 50 is configured to have a plate body and a pair of lateralextensions 70 that extend from the plate body, each of which has aprotrusion 71, for inserting into a corresponding notch 17 of the spacer10. These lateral extensions 70 help form the first locking mechanismbetween the plate 50 and the spacer 10, as discussed above. In addition,the lateral extensions 70 of the plate 50 each include a window 72(shown in FIG. 2A) for receiving a hump region 26 on the arms 17 of thespacer 10, thereby helping to form the second locking mechanism betweenthe plate 50 and the spacer 10, as discussed above.

In addition to attaching to the spacer 10, the plate 50 is alsoconfigured to attach into one or more vertebral bodies via one or morebone screws. As shown in FIG. 1A, the plate 50 includes a first screwhole 52 and a second screw hole 54 for receiving bone screws therein. Insome embodiments, screw hole 52 is angled upwardly such that an insertedbone screw passes upward into an upper vertebral body, while screw hole54 is angled downwardly such that an inserted bone screw passes downwardinto a lower vertebral body. While the illustrated embodimentillustrates a pair of screw holes for receiving a pair of bone screws,it is possible to have one, three, four, five or more screw holes forreceiving a different number of bone screws.

Over time, it is possible for bone screws to back-out. The plate 50 thushas a blocking or set screw 56 (shown in FIG. 1C) that assists inpreventing back-out of inserted bone screws. As shown in FIG. 1C, theset screw 56 can be in an initial position that allows first and secondbone screws to pass through holes 52, 54. Once the bone screws have beeninserted through the holes 52, 54, the set screw 56 can be rotated(e.g., 90 degrees), to thereby block the bone screws and prevent backout of the bone screws. In some embodiments, the set screw 56 abuts aside of the head of the bone screws to prevent back-out of the bonescrews, while in other embodiments, the set screw 56 rests over a top ofthe head of the bone screws to prevent back-out of the bone screws. Insome embodiments, the set screw 56 comes pre-fixed with the plate 50. Asshown in FIG. 1C, a single set screw 56 can be used to convenientlyblock a pair of bone screws. In other embodiments, each bone screw canbe assigned its own set screw, which can operate independently of oneanother, to prevent back-out of the bone screw.

The plate 50 can also include one or more knife-like edges 63 thatprovide additional torsional stabilization when the plate 50 restsagainst a bone member. As shown in FIG. 1C, the knife-like edges 63 canbe formed on both the upper and lower surfaces of the plate 50 body.While the illustrated embodiment shows a pair of knife-like edges 63 onan upper surface of the plate body and a pair of knife-like edges 63 ona lower surface of the plate body, one skilled in the art willappreciate that a different number of knife-like edges 63 can beprovided.

FIGS. 2A-2D illustrate different views of the low profile plate shown inFIGS. 1A-1D. From these views, one can see the pair of lateralextensions 70 that extend from the body of the plate 50. At the distalend of each of the lateral extensions 70 is an inwardly-facingprotrusion 71 that is configured to fit into a corresponding notch inthe spacer 10. In addition, from these views, one can see the windows 72that are formed in each of the lateral extensions 70. The windows 72advantageously receive hump regions 26 of the spacer to provide alocking mechanism, and also help to improve desirable radiolucency.Advantageously, the windows 72 can have rounded edges to accommodate thespacer 10 therein. While the illustrated windows 72 are shown asrectangular with rounded edges, in other embodiments, the windows 72 canhave a different shape, such as circular or oval. In some embodiments,the plate 50 is assembled axially to the spacer 10.

In some embodiments, the low profile plate 50 can also include indentedgripping sections 73 (shown in FIGS. 2A and 2B). These indented grippingsections 73 advantageously provide a gripping surface for an insertioninstrument, thereby facilitating easy delivery of the plate to a spacerbody during surgery.

FIGS. 3A-3D illustrate different views of a PEEK spacer to be used withthe low profile plate shown in FIGS. 2A-2D. From these views, one cansee how the spacer 10 a includes an upper surface 12 a and a lowersurface 14 a with texturing 16 a; a generally C-shaped body including apair of arms 13 a each having a notch 17 a formed therein and an upperchamfer 18 a or lower chamfer 19 a; and a tapered leading edge 22 a. Inaddition, one skilled in the art can appreciate the substantiallysymmetric shape of the inner opening 20 a, which serves as a graft holefor receiving graft material therein.

FIGS. 4A-4D illustrate different views of an allograft spacer to be usedwith the lower profile plate shown in FIGS. 2A-2D. While the allograftspacer lab shares similar features to the PEEK spacer 10 a shown inprevious figures, such as the notches 17 b, hump surfaces 26 b, andchamfers 18 b,19 b, the allograft spacer 10 need not be the same. Forexample, the shape of the graft opening 20 b can be more of an arch, asshown in FIG. 4B.

FIGS. 5A-5D illustrate different views of a second alternativeembodiment of a low profile plate attached to a spacer according to someembodiments. Rather than having a plate 50 with lateral extensions 70that extend around the outer surface of a spacer 10, the presentembodiment of the plating system 105 includes a plate 150 with anenclosed posterior extension 155 that fits within the body of the spacer110. The enclosed posterior extension 155 includes extending surfaces166, 167 that are fitted into corresponding inlets 121, 123 formed inthe body of the spacer 120, thereby forming a first locking mechanismbetween the plate 150 and the spacer 110. In addition, the enclosedposterior extension 155 of the plate 50 includes one or more deformablelocking tabs 160 (shown in FIG. 6B) that securely lock into tab holes181 a in the spacer body 110, thereby forming a second locking mechanismbetween the plate 150 and the spacer 110. While in some embodiments, theplate 150 can be attached to the spacer 110 after inserting the spacer110 into a desired location in the body, in other embodiments, the plate150 can be pre-assembled with the spacer 110 prior to inserting theplating system 105 into the desired location.

Like the spacer 10 in FIG. 1A, the spacer 110 is configured to have anupper surface 112, a lower surface 114, and a leading end 122. In someembodiments, the upper surface 112 and/or lower surface 114 includestexturing 116, such as teeth, ribs, ripples, etc. to assist in providingfrictional contact with adjacent vertebral bodies. In some embodiments,the leading end 122 of the spacer 110 can be slightly tapered, as shownin FIG. 7D. With the taper, the leading end 122 can serve as adistraction surface that helps the spacer 110 to be inserted into anintervertebral space. As shown in FIG. 1B, the leading end 122 can beconcave, though in other embodiments, the leading end 122 can bestraight or convex.

The spacer 110 can be substantially C-shaped (as shown in FIG. 7B),whereby it includes two side arms 113 that surround an inner opening120. Adjacent the side aims 113 is a straight wall 119 that forms theborder of the graft opening 120. The straight wall 119 can include oneor more tab holes 181 (shown in FIG. 7A) for receiving deformable tablocks 160 therein. The graft opening 20, which is configured to receivenatural or synthetic grail material therein to assist in a fusionprocedure, has an open side that is opposite the straight wall 119,thereby giving the spacer 110 its C-shape.

In some embodiments, the graft opening 120 (shown in FIG. 7B) has adifferent shape from the opening 20 of the spacer 10 of the priorembodiment, as the graft opening 120 is configured to not only receivegraft material, but also the enclosed posterior extension 155 of theplate 150. For example, the graft opening 120 includes two inlets—afirst inlet 121 formed at the junction between the first arm 113 andwall 119 and a second inlet 123 formed at the junction between thesecond arm 113 and wall 119 (shown in FIG. 7B)—for receiving outwardlyextending surfaces 166, 167 of the plate 150 (shown in FIG. 6B). Inaddition, the graft opening 120 includes two outwardly tapering walls111 that provide enough space to accommodate any bone screws inserted inthe plate 150. As such, additional chamfers 18, 19 (as shown in FIG. 3B)are optional.

Like spacer 10, the spacer 110 can be formed of a variety of materials.In some embodiments, the spacer 110 comprises PEEK, as shown in FIG. 7A,while in other embodiments, the spacer 110 comprises allograft bone, asshown in FIG. 8A.

The plate 150 is configured to have a plate body, and an enclosedposterior extension 155 that extends from the plate body, which isreceived within and retains the spacer 110. The enclosed posteriorextension 155 includes first and second outwardly extending surfaces166, 167 that fit into inlets 121, 123 formed within the spacer 110 bodyto form a first locking mechanism. In addition, one or more deformabletab locks 160 extend from an exterior surface of the enclosed posteriorextension 155 and are received in corresponding tab holes 181 in thespacer 150 to form a second locking mechanism. In some embodiments, theside walls of the enclosed posterior extension 155 can include one ormore windows 172 (shown in FIG. 6A) for improving radiolucency of theplating system. In some embodiments, the plate 150 is assembled axiallyto the spacer 110.

In addition to attaching to the spacer 110, the plate 150 is alsoconfigured to attach into one or more vertebral bodies via one or morebone screws 88, 89. As shown in FIG. 5A, the plate 150 includes a firstscrew hole 152 and a second screw hole 154 for receiving bone screws 88,89 therein. In some embodiments, screw hole 152 is angled upwardly suchthat an inserted bone screw 88 passes upward into an upper vertebralbody, while screw hole 154 is angled downwardly such that an insertedbone screw 89 passes downward into a lower vertebral body. While theillustrated embodiment illustrates a pair of screw holes for receiving apair of bone screws, it is possible to have one, three, four, five ormore screw holes for receiving a different number of bone screws.

Over time, it is possible for bone screws to back-out. The plate 150thus has a blocking or set screw 156 (shown in FIG. 5C) that assists inpreventing back-out of inserted bone screws. As shown in FIG. 5C, theset screw 156 can be in an initial position that allows first and secondbone screws to pass through holes 152, 154. Once the bone screws havebeen inserted through the holes 152, 154, the set screw 156 can berotated (e.g., 90 degrees), to thereby block the bone screws and preventback out of the bone screws. In some embodiments, the set screw 156abuts a side of the head of the bone screws to prevent back-out of thebone screws, while in other embodiments, the set screw 156 rests over atop of the head of the bone screws to prevent back-out of the bonescrews. In some embodiments, the set screw 156 comes pre-fixed with theplate 150. As shown in FIG. 5C, a single set screw 156 can be used toconveniently block a pair of bone screws. In other embodiments, eachbone screw can be assigned its own set screw, which can operateindependently of one another, to prevent back-out of the bone screw.

The plate 150 can also include one or more knife-like edges 163 thatprovide additional torsional stabilization when the plate 150 restsagainst a bone member. As shown in FIG. 5C, the knife-like edges 163 canbe formed on both the upper and lower surfaces of the plate 150 body.While the illustrated embodiment shows a pair of knife-like edges 163 onan upper surface of the plate body and a pair of knife-like edges 163 ona lower surface of the plate body, one skilled in the art willappreciate that a different number of knife-like edges 163 can beprovided.

FIGS. 6A-6D illustrate different views of the low profile plate shown inFIGS. 5A-5D. From these views, one can see the enclosed posteriorextension 155 that extends from the body of the plate 150. At the distalend of the enclosed posterior extension 155 are a pair of outwardlyextending surfaces 166, 167 that are configured to fit within inlets121, 123 formed in the spacer. From these views, one can also see thedeformable tab lock 160 (FIG. 6B) that can help secure the plate 150 tothe spacer 110. In addition, from these views, one can see the windows172 that are formed in each of the arms of the enclosed posteriorextension 155. The windows 172 advantageously help to improve desirableradiolucency, and are of large size to provide a large viewing surfacearea. While the illustrated windows 172 are shown as triangular withrounded edges, in other embodiments, the windows 172 can have adifferent shape, such as circular or oval In some embodiments, the plate150 is assembled axially to the spacer 110.

In some embodiments, the low profile plate 150 can also include indentedgripping sections 173 (shown in FIGS. 6A and 6B). These indentedgripping sections 173 advantageously provide a gripping surface for aninsertion instrument, thereby facilitating easy delivery of the plate toa spacer body during surgery.

FIGS. 7A-7D illustrate different views of a PEEK spacer to be used withthe low profile plate shown in FIGS. 5A-5D. From these views, one cansee how the spacer 110 a includes an upper surface 112 a and a lowersurface 114 a with texturing 116 a; a generally C-shaped body includinga pair of arms 113 a each having an inner inlet 121, 123 a formedtherein; and a tapered leading edge 122 a. In addition, one skilled inthe art can appreciate the substantially symmetric shape of the inneropening 120 a, which serves as a graft hole for receiving graft materialtherein.

FIGS. 8A-8D illustrate different views of an allograft spacer to be usedwith the lower profile plate shown in FIGS. 5A-5D. While the allograftspacer 110 b shares similar features to the PEEK spacer 110 a shown inprevious figures, such as the C-shaped body including a pair of arms 113b each having an inlet 121 b, 123 b formed therein, the allograft spacer110 b need not be the same.

FIGS. 9A-9D illustrate different views of a third alternative embodimentof a low profile plate attached to a spacer according to someembodiments. In the present embodiment, the plating system 205 includesa plate 250 having lateral arms or extensions 270 that extend around anexterior surface of a spacer 210. The lateral extensions 270 extendwider than the lateral extensions 70 in the first embodiment, and do notnecessarily have to interlock with the spacer 210. While in someembodiments, the plate 250 can be attached to the spacer 210 afterinserting the spacer 210 into a desired location in the body, in otherembodiments, the plate 250 can be pre-assembled with the spacer 210prior to inserting the plating system 205 into the desired location.

Like the spacer 10 in FIG. 1A, the spacer 210 is configured to have anupper surface 212, a lower surface 214, and a leading end 222. In someembodiments, the upper surface 212 and/or lower surface 214 includestexturing 216, such as teeth, ribs, ripples, etc. to assist in providingfrictional contact with adjacent vertebral bodies. In some embodiments,the leading end 222 of the spacer 210 can be slightly tapered, as shownin FIG. 9D. With the taper, the leading end 222 can serve as adistraction surface that helps the spacer 210 to be inserted into anintervertebral space. As shown in FIG. 9B, the leading end 222 can beslightly concave, though in other embodiments, the leading end 122 canbe straight or convex. Unlike previously illustrated spacers, the spacer210 can have a graft hole 220 that is completely enclosed. As shown inFIG. 913, the graft hole 220 can surrounded by four walls. In addition,the spacer 210 can include four outer walls: two straight walls, aconvex wall and a concave wall.

In some embodiments, the graft opening 220 (shown in FIG. 9B) has adifferent shape from the openings of prior embodiments, as the graftopening 220 is enclosed. While the graft opening 220 is rectangular withrounded edges, in other embodiments, the graft opening 220 can have adifferent shape. For example, in some embodiments, the graft opening 220can have curved walls, instead of straight walls, or can have taperedwalls, instead of straight walls.

Like spacer 10, the spacer 210 can be formed of a variety of materials.In some embodiments, the spacer 210 comprises allograft bone, while inother embodiments, the spacer 210 comprises PEEK.

The plate 250 is configured to have a pair of lateral extensions 270that receive the spacer 220. As shown in FIG. 9A, in some embodiments,the lateral extensions 270 include one or more windows 272 for improvingradiolucency of the plating system. In some embodiments, the plate 250is assembled axially to the spacer 210.

In addition to capturing the spacer 210, the plate 250 is alsoconfigured to attach into one or more vertebral bodies via one or morebone screws 88, 89. As shown in FIG. 9A, the plate 250 includes a firstscrew hole 252 and a second screw hole 254 for receiving bone screws 88,89 therein. In some embodiments, screw hole 252 is angled upwardly suchthat an inserted bone screw 88 passes upward into an upper vertebralbody, while screw hole 254 is angled downwardly such that an insertedbone screw 89 passes downward into a lower vertebral body. While theillustrated embodiment illustrates a pair of screw holes for receiving apair of bone screws, it is possible to have one, three, four, five ormore screw holes for receiving a different number of bone screws.

Over time, it is possible for bone screws to back-out. The plate 250thus has a blocking or set screw 256 (shown in FIG. 9C) that assists inpreventing back-out of inserted bone screws. As shown in FIG. 9C, theset screw 256 can be in an initial position that allows first and secondbone screws to pass through holes 252, 254. Once the bone screws havebeen inserted through the holes 252, 254, the set screw 256 can berotated (e.g., 90 degrees), to thereby block the bone screws and preventback out of the bone screws. In some embodiments, the set screw 256abuts a side of the head of the bone screws to prevent back-out of thebone screws, white in other embodiments, the set screw 256 rests over atop of the head of the bone screws to prevent back-out of the bonescrews. In some embodiments, the set screw 256 comes pre-fixed with theplate 250. As shown in FIG. 9C, a single set screw 256 can be used toconveniently block a pair of bone screws. In other embodiments, eachbone screw can be assigned its own set screw, which can operateindependently of one another, to prevent back-out of the bone screw.

FIGS. 10A-10D illustrate different views of the low profile plate shownin FIGS. 9A-9D. From these views, one can see the lateral extensions 270that extend from the body of the plate 250. From these views, one canalso see the windows 272 (FIG. 10A) that extend along a substantiallength of the lateral extensions 270. In some embodiments, each window272 has a length greater than half the length of each lateral extension270, thereby advantageously increasing the radiolucency of the platingsystem. In some embodiments, the plate 250 is assembled axially to thespacer 210.

In some embodiments, the low profile plate 250 can also include indentedgripping sections 273 (shown in FIGS. 10A and 10B). These indentedgripping sections 273 advantageously provide a gripping surface for aninsertion instrument, thereby facilitating easy delivery of the plate toa spacer body during surgery.

FIGS. 11A-11D illustrate different views of a fourth alternativeembodiment of a low profile plate attached to a spacer according to someembodiments. Like the previous embodiment, the plating system 305includes a plate 350 having lateral arms or extensions 370 that extendaround an exterior surface of a spacer 310. The lateral extensions 370extend wider than the lateral extensions 70 in the first embodiment, anddo not necessarily have to interlock with the spacer 310. While in someembodiments, the plate 350 can be attached to the spacer 310 afterinserting the spacer 310 into a desired location in the body, in otherembodiments, the plate 350 can be pre-assembled with the spacer 310prior to inserting the plating system 305 into the desired location.

Like the spacer 10 in FIG. 1A, the spacer 310 is configured to have anupper surface 312, a lower surface 314, and a leading end 322. In someembodiments, the upper surface 312 and/or lower surface 314 includestexturing 316, such as teeth, ribs, ripples, etc, to assist in providingfrictional contact with adjacent vertebral bodies. In some embodiments,the leading end 322 of the spacer 310 can be slightly tapered, as shownin FIG. 11D. With the taper, the leading end 322 can serve as adistraction surface that helps the spacer 310 to be inserted into anintervertebral space. As shown in FIG. 11B, the leading end 322 can beslightly concave, though in other embodiments, the leading end 322 canbe straight or convex. In some embodiments, the spacer 310 can have agraft hole 320 that is completely enclosed. As shown in FIG. 11B, thegraft hole 320 can surrounded by four walls. In addition, the spacer 320can be comprised of four outer walls: two straight, one concave and oneconvex.

In some embodiments, the graft opening 320 (shown in FIG. 11B) of thespacer 310 is enclosed. While the graft opening 320 is rectangular withrounded edges, in other embodiments, the graft opening 320 can have adifferent shape. For example, in some embodiments, the graft opening 320can have curved walls, instead of straight walls, or can have taperedwalls, instead of straight walls.

Like spacer 10, the spacer 310 can be formed of a variety of materials.In some embodiments, the spacer 210 comprises allograft bone, while inother embodiments, the spacer 310 comprises PEEK.

The plate 350 is configured to have a pair of lateral extensions 370that receive the spacer 320. As shown in FIG. 11A, in some embodiments,the lateral extensions 370 include one or more windows 372 for improvingradiolucency of the plating system. In some embodiments, the plate 350is assembled axially to the spacer 310.

In addition to capturing the spacer 310, the plate 350 is alsoconfigured to attach into one or more vertebral bodies via one or morebone screws 88, 89. As shown in FIG. 9A, the plate 350 includes a firstscrew hole 351, a second screw hole 352 and a third screw hole 354 forreceiving bone screws 87, 88, 89 therein. In some embodiments, screwholes 352 and 354 are angled upwardly such that inserted bone screws 87,88 pass upward into an upper vertebral body, while screw hole 351 isangled downwardly such that inserted bone screw 89 passes downward intoa lower vertebral body. While the illustrated embodiment illustratesthree screw holes for receiving three bone screws, it is possible tohave one, two, four, five or more screw holes for receiving a differentnumber of bone screws.

Over time, it is possible for bone screws to back-out. The plate 350thus has blocking or set screws 356, 357, 358 (shown in FIG. 2C), eachof which corresponds to one of screw holes 351, 352, 354. As shown inFIG. 12C, the set screws 356, 357, 358 can be in an initial positionthat allows first, second and third bone screws to pass through holes351, 352, 354. Once the bone screws have been inserted through the holes351, 352, 354, the set screws 356, 357, 358 can be rotated (e.g., 90degrees), to thereby block the bone screws and prevent back out of thebone screws. In some embodiments, the set screws 356, 357, 358 abut aside of the head of the bone screws to prevent back-out of the bonescrews, while in other embodiments, the set screws 356, 357, 358 restover a top of the head of the bone screws to prevent back-out of thebone screws. In some embodiments, the set screws 356, 357, 358 comepre-fixed with the plate 350. As shown in FIG. 12C, a single set screw356, 357, 358 can be used to conveniently block a single bone screws. Inother embodiments, each set screw can be designed to block more than oneset screw to prevent back-out of the bone screw.

FIGS. 12A-12D illustrate different views of the low profile plate shownin FIGS. 11A-11D. From these views, one can see the lateral extensions370 that extend from the body of the plate 350. From these views, onecan also see the windows 372 (FIG. 12A) that extend along a substantiallength of the lateral extensions 370. In some embodiments, each window372 has a length greater than half the length of each lateral extension370, thereby advantageously increasing the radiolucency of the platingsystem. In some embodiments, the plate 350 is assembled axially to thespacer 310.

The plating systems describe include a plate that is independent from aspacer. The plate is low-profile and can be used with any type ofspacer, such as allograft or PEEK.

FIGS. 13A-13D illustrate different views of a multi-piece allograftspacer to be used with the low profile plates discussed above accordingto some embodiments. The multi-piece allograft spacer 410 can be formedof an upper member 436 and a lower member 438 that are connectedtogether via one or more pins 475. The upper member 436 and the lowermember 438 each include cut-out portions that help form a graft opening420 in the spacer 410.

The upper member 436 can include an upper surface having bone engagementsurfaces (e.g., ridges, teeth, ribs) and a lower interfacing surface446. The lower member 438 can include a lower surface having boneengagement surfaces (e.g., ridges, teeth, ribs) and an upper interfacingsurface 448. In some embodiments, the upper member 436 can include oneor more holes 462, while the lower member 438 can include one or moreholes 464 which align with the one or more holes 462 of the uppermember. The aligned holes are configured to receive one or more pins 475to keep the upper and lower members of the allograft spacer together. Insome embodiments, the pins 475 are also formed of bone material, such asallograft.

As shown best in FIG. 13C, the lower interfacing surface 446 of theupper member 436 is directly engaged with the upper interfacing surface448 of the lower member 438. While the lower interfacing surface 446 andthe upper interfacing surface 448 can be flat-on-flat, as both surfacesare planar, in some embodiments (as shown in FIG. 13C), the interfacebetween the two surfaces is at an angle relative to the holes forreceiving the pins 475. In other words, the pins 475 are received at anangle to the interface between the upper member 436 and the lower member438. In addition, as shown in FIG. 13C, holes 462 and 464 need not gothrough the entirety of their respective members. For example, as shownin FIG. 13C, while hole 462 goes entirely through the upper and lowersurface of the upper member 436, hole 464 goes only through the uppersurface of the lower member 438, and does not go through to the lowersurface. Accordingly, in some embodiments, aligned holes 462 and 464create a “blind” pin-hole, whereby the hole does not go through theuppermost and lowermost surfaces of the spacer 410. Advantageously, insome embodiments, the use of such blind holes for receiving pins helpsto maintain the pins within the spacer body.

FIGS. 14A-14D illustrate different views of an alternative multi-pieceallograft spacer to be used with the lower profile plates discussedabove according to some embodiments. The multi-piece allograft spacer510 can be formed of a left member 536 and a right member 538 that areconnected together in series or side-by-side (e.g., laterally) via oneor more pins 575. The left member 536 and the right member 538 eachinclude cut-out portions that help form a graft opening 520 in thespacer 510.

The left member 536 can include upper and lower surfaces having boneengagement surfaces (e.g., ridges, teeth, ribs). In addition, the leftmember 536 further includes a right interfacing surface 546. The rightmember 538 can also include upper and lower surfaces having boneengagement surfaces (e.g., ridges, teeth, ribs). In addition, the rightmember 538 further includes a left interfacing surface 548. In someembodiments, the left member 536 can include one or more holes 562,white the right member 538 can include one or more holes 564 which alignwith the one or more holes 562 of the left member. The aligned holes areconfigured to receive one or more pins 575 to keep the left and rightmembers of the allograft spacer together.

As shown best in FIG. 14A, the right interfacing surface 546 of the leftmember 536 is directly engaged with the left interfacing surface 548 ofthe right member 538. While the right interfacing surface 546 and theleft interfacing surface 548 can be flat-on-flat, as both surfaces areplanar, in some embodiments (as shown in FIG. 4A), the interface betweenthe two surfaces is at an angle relative to the holes for receiving thepins 575. In other words, the pins 575 are received at an angle to theinterface between the left member 536 and ate right member 538. Inaddition, as shown in FIG. 14B, holes 562 and 564 need not go throughthe entirety of their respective members. In other words, one or more ofthe holes (e.g., holes 562, 564 or combined) can be blind holes, wherebythe holes do not go through the left and right surfaces of the lateralimplants.

By having multi-piece allograft spacers that are either stacked oraligned side-by-side, it is possible to have spacers of increased heightand width. While the embodiments herein show two piece spacers, oneskilled in the art will appreciate that three or more members can becombined to form multi-piece allograft spacers for use with any of theplate members described above.

FIGS. 15A-15D illustrate different views of an alternative low profileplate attached to a spacer according to some embodiments, The platingsystem 605 comprises a plate 650 attached or mounted to a spacer 610.

The system 605 includes a number of similar features to priorembodiments. The spacer 610 includes a body having an upper surface 612and a lower surface 614 with texturing (e.g., ribs, grooves, teeth,protrusions) and sidewalls including one or more notches 617 forreceiving plate extensions. The body of the spacer 610 can be U-shapedor C-shaped, such that a central portion includes a graft opening 620for receiving graft material therein. The plate 650 includes a bodyhaving a first screw hole 652 for receiving a first screw membertherethrough, a second screw hole 654 for receiving a second screwmember therethrough, and a recess for receiving a blocking fastener orset screw 656. In addition, a pair of extension arms or members 617extend from the plate body and are received in each of the notches 617formed in the spacer 10. Each of the extension members 617 includes awindow 672 for receiving a hump portion or region of the spacer tofurther secure the spacer 610 with the plate 650. In addition, the platemember 650 can include one or more stabilizers or knife-like edges 663that can help secure the plate member 650 to a vertebral body. While thestabilizers 663 are shown as sharp and pointed, in other embodiments,the stabilizers 663 are more blunt and in some cases, even slightlyrounded.

The plating system 605 in FIGS. 15A and 15D is unique in that the firstupper screw hole 652 has been raised such that a central axis of thefirst upper screw hole 652 is positioned higher than the upper surface612 of the spacer 610. In addition, the second lower screw hole 654 hasbeen towered such that a central axis of the second lower screw hole 654is positioned below the lower surface 614 of the spacer 610. As shown inFIG. 15B, each of the holes 652, 654 has an adjacent brow member thatextends from the plate body. First screw hole 652 is adjacent upper browmember 662, while second screw hole 654 is adjacent lower brow member664. Upper brow member 662 has been raised to accommodate the raisedupper screw hole 652, while lower brow member 664 has been lowered toaccommodate the lowered lower screw hole 654. Advantageously, by raisingthe upper screw hole 652 and lowering the lower screw hole 654, thisreduces the likelihood of any viewing obstruction that may occur fromthe spacer 610. Moreover, even though the upper brow member 662 israised and the lower brow member 664 is lowered, advantageously, theplating system 605 still maintains a low profile such that most if notall of the plate system remains in a disc space. In other embodiments,it may be desired for a part of the upper brow member 662, a part of thelower brow member 664 or both to contact a vertebral face (e.g., ananterior face), thereby providing stability to the plating system 605.

FIGS. 16A-16D illustrate different views of a plate member 650 used inthe plating system 605. From these views, one can clearly see how theupper brow member 662 and first upper hole member 652 have been raised,while the lower brow member 664 and second lower hole member 664 havebeen lowered, relative to other designs. In some embodiments, the entirecentral axis of first upper hole member 652 (e.g., from a front of theplate member 650 to a back of the plate member 650) is continuouslyabove the upper surface of the spacer, thereby advantageously providinga less unobstructed view of the first upper hole member 652. Likewise,in some embodiments, the entire central axis of the second lower holemember 654 (e.g., from a front of the plate member 650 to a back of theplate member 650) is continuously below the lower surface of the spacer,thereby advantageously providing a less unobstructed view of the secondlower hole member 654.

FIGS. 17A-17C illustrate different views of a spacer 610 used in theplating system 605. From these views, one can clearly see features ofthe spacer 610 includes its upper surface 612, lower surface 614,sidewalls with notches 617 and graft opening 620. In addition, with theplate member removed from the views, one can also see an upper chamfer618 a and a lower chamfer 618 b that are cut into the spacer 610. Thesechamfers 618 a, 618 b advantageously provide clearance for bone screwsthat are inserted through the plating system 605. One skilled in the artwill appreciate that the spacer can be made of many different materials.In some embodiments, the spacer will be made out of bone (e.g.,allograft), while in other embodiments, the spacer will be made of PEEK.Advantageously, the plating system 605 is removably attached to thespacer 610 such that a surgeon can choose to include a spacer of acertain material as so desired during a surgical procedure.

FIGS. 18A-18D illustrate different views of yet another plate systeminvolving a plate member and a spacer having a unique multi-piececomposition in accordance with some embodiments. The plate system 705includes similar elements as found in prior embodiments, including aplate member 750 having a first upwardly oriented screw hole 752 forreceiving a first screw, a second downwardly oriented screw hole 754 forreceiving a second screw, and a blocking member or screw 756, as well asa spacer 710 (e.g., allograft or PEEK) having an upper surface 712, alower surface 714, a graft opening 720, and notches 717 for receivingaims or extensions 770 of the plate member 750. The plate member 750also includes one or more windows 772 in its extensions 770 forreceiving a raised or bump out portion of the spacer 705, therebyhelping to retain the spacer 705 within the plate member 750. Inaddition, the plate member 750 includes stabilizers 763 in the form ofknife-like edges that help to grip into a vertebral body.

In addition to these features, the spacer 710 has a unique multi-piececomposition. As shown in FIGS. 18A and 18D, in some embodiments, thespacer 710 has a body formed of two adjacent members—a first member 711and a second member 713. The first member 711 and the second member 713can be held together via one or more pin members, although in otherembodiments, the first member 711 and second member 713 can be held viaadhesive, mateable connections, etc. As shown in FIG. 18D, second member713 can include an upper overhang region 717 that hangs over a part ofthe first member 711. Similarly, first member 711 can include a loweroverhang region 711 that hangs below a part of the second member 713.Advantageously, these overhang regions 711 serve as guides to identifythe location of the interface 715 between the first member 711 and thesecond member 713. During manufacturing, the overhang regions 711 makeit easy to inspect the interface to 715 to ensure that the two members711, 713 are property secured together. White the illustrated embodimentshows a spacer 710 having two separate overhanging regions, in otherembodiments, the spacer 710 can have one single overhanging region. Asbefore, the spacer 710 can be made of many different types of materials,including bone (e.g., allograft) and PEEK), and a surgeon canadvantageously decide what type of spacer should accompany the platebefore or during surgery.

FIG. 19 shows a plating system 805 having a plate member 850 havingextensions 870 and a spacer 810 similar to that found in FIGS. 18A-18D;however, the spacer 810 is designed to accommodate lordosis. In otherwords, while the upper surface 712 and lower surface 714 of the spacer710 can be substantially parallel (as shown in FIG. 18C), the uppersurface 812 and lower surface 814 of the spacer 810 can have some degreeof angulation or lordosis. In some embodiments, relative to a mid-lineof the spacer 810, the upper surface 812 and/or lower surface 814 canhave a degree of angulation of 2, 3, 5, 7, 12 degrees or more.Advantageously, the lordotic spacer 810 (which is accompanied with theplate member 850) helps to accommodate different anatomies.

FIGS. 20A-20D show yet another alternative plating system having a platemember attached to multiple spacers in accordance with embodiments ofthe present application. The unique plating system 905 comprises a platemember 950 having a pair of inner arms or extensions 975 and a pair ofouter arms or extensions 970 for receiving one or more spacers 910therein. In some embodiments, the inner and outer extensions 975, 970include protruding portions designed to be received in notches in theone or more spacers.

As shown in FIG. 20A, the plating system 905 includes a first spacer 910a that is retained between a shorter outer extension 970 and a longerinner extension 975 of the plate member 950. The shorter outer extension970 of the plate is configured to be received in notch 917 of the spacer910 a, while the longer inner extension 975 of the plate is configuredto be received in notch of the spacer 910 a. In addition,advantageously, the shorter outer extension 970 includes a window 972and the longer inner extension 975 includes a window 974. Each of thewindows 972, 974 is configured to receive a bump out portion of thespacer 910, thereby helping to retain the spacer 910 to the plate member905. In addition, the windows 972, 974 help to provide a means tovisualize fusion (e.g., in a lateral image) that is occurring once thespacer is implanted within a disc space. Similarly, the plating system905 includes a second spacer 910 b that is retained between a shorterouter extension 970 and a longer inner extension 975 on an opposite sideof the plate member 950. While in the present embodiment, each of thelonger inner extensions 975 is separated from the other without anyconnecting member, in other embodiments, a connection bar or bridge(such as shown in FIGS. 21A and 21B) can extend between the two innerextensions 975. Advantageously, when the plating system 905 is placed ina disc space, graft material can be packed between the two innerextensions 975 to promote fusion within the disc space.

Advantageously, in accordance with some embodiments, the plating system905 is designed to hold at least two spacers 910 a, 910 b. In someembodiments, the spacers 910 a, 910 b are substantially rectangularpieces. In some embodiments, the spacers 910 a, 910 b can havesubstantially rounded edges. In some embodiments, the spacers 910 a, 910b can include one or more chamfers 918 for providing clearance for oneor more screws that are inserted through the plate member 905. Forexample, spacer 910 a can include a chamfer that provides clearance fora screw that passes through plate opening 954, white spacer 910 b caninclude a chamfer that provides clearance for a screw that passesthrough plate opening 952. Advantageously, the use of two spacers 910 a,910 b —one on each side of the plate system 905 —helps to stabilize theplate system within the disc space. Moreover, having multiple individualspacers 910 a, 910 b that are smaller in size can ease manufacturingissues, as the spacers can be formed of relatively small pieces of bone,which can be easier to find than larger pieces of bone. In other words,bone that is removed from a body can improve the yield of production, asit will be easier to create the spacer members. While the spacers 910 a,910 b are illustrated as being single-bodied members in the presentembodiments, in other embodiments, the spacers can be formed of multiplepieces (e.g., pinned together).

FIGS. 21A and 21B illustrate different views of another alternative lowprofile plate attached to multiple spacers according to someembodiments. The plate system 1005 comprises a plate member 1050attached to a pair of spacers 1010 a and 1010 b. Like the embodiment inFIG. 20A, the plate member 1050 of the present embodiment includes apair of outer arms or extensions 1070 a, 1070 b and a pair of inner armsor extensions 1075 a, 1075 b. Plate extensions 1070 a and 1075 a areconfigured to retain spacer 1010 a, while plate extensions 1070 b and1075 b are configured to retain spacer 1010 b. As shown in FIGS. 21A and21B, the inner extensions 1075 a and 1075 b includes a connection orbridge member 1088 that extends between them. Advantageously, the bridgemember 1088 helps provide added stability to the plate system 1005, andalso helps provide a barrier to retain graft material within the platesystem 1005. As shown in FIG. 21A, in some embodiments, the innerextensions 1075 a and 1075 b are parallel to one another.

As shown in FIG. 21B, outer plate extensions 1070 a and 1070 b includeat least one window 1072 formed therein. Similarly, inner plateextensions 1075 a and 1075 b include at least one window formed therein.As shown in FIG. 21B, inner plate extensions each include twowindows—1074 and 1075—that are formed adjacent to one another. Innerplate extension 1075 a includes windows 1074 a and 1075 a, while innerplate extension 1075 b includes windows 1074 b and 1075 b. In someembodiments, the windows 1072, 1074, 1075 can advantageously be designedto hold a bump out portion of the spacers and/or provide increasedvisualization to a surgeon during or after a fusion procedure. While insome embodiments, each of the windows 1072, 1074, and 1075 perform thesame duties and functions, in other embodiments, the windows can performdifferent functions. For example, while inner window 1074 can be used toboth retain the spacer and aid in fusion visualization, inner window1075 can be used simply for fusion visualization.

FIG. 22 illustrates another alternative low profile plate attached tomultiple spacers according to some embodiments. The plate system 1105comprises a plate member 1150 attached to a pair of spacers 1110 a and1110 b. Like the embodiment in FIG. 21A, the plate member 1150 of thepresent embodiment includes a pair of outer arms or extensions 1170 a,1170 b and a pair of inner arms or extensions 1175 a, 1175 b. Plateextensions 1170 a and 1175 a are configured to retain spacer 1110 a,while plate extensions 1170 b and 1175 b are configured to retain spacer1110 b. As shown in FIGS. 21A and 21B, the inner extensions 1175 a and1175 b includes a connection or bridge member 1188 that extends betweenthem. Advantageously, the bridge member 1188 helps provide addedstability to the plate system 1105, and also helps provide a barrier toretain graft material within the plate system 1105. In contrast to theinner extensions 1075 a, 1075 b in FIG. 21A, the inner extensions 1175a, 1175 b are non-parallel and angulated relative to one another.Furthermore, due to the shape of the plate member 1150, the shapes ofthe individual spacers 1110 a and 1110 b differ in that they have aprominent angled surface adjacent to the inner extensions 1175 a, 1175b.

FIG. 23 illustrates another alternative low profile plate attached tomultiple spacers according to some embodiments. The plate system 1205comprises a plate member 1250 attached to a pair of spacers 1210 a and1210 b. Like the embodiment in FIG. 22, the plate member 1250 of thepresent embodiment includes a pair of outer arms or extensions 1270 a,1270 b and a pair of inner arms or extensions 1275 a, 1275 b. Plateextensions 1270 a and 1275 a are configured to retain spacer 1210 a,white plate extensions |270 b and 1275 b are configured to retain spacer1210 b. As shown in FIGS. 23, the inner extensions 1275 a and 1275 bincludes a connection or bridge member 1288 that extends between them.Advantageously, the bridge member 1288 helps provide added stability tothe plate system 1205, and also helps provide a barrier to retain graftmaterial within the plate system 1205. In contrast to the bridge member1188 in FIG. 22, the bridge member 1288 is elongated and extends to adistal end of the spacers 1210 a, 1210 b, thereby creating an evenlarger space for receiving graft material in the middle of the platesystem 1205.

FIGS. 24A-24C illustrate another alternative low profile plate attachedto multiple spacers according to some embodiments. The plate system 1305comprises a plate member 1350 attached to a multi-piece spacer 1310formed of three members 1310 a, 1310 b, 1310 c. Like the embodiment inFIG. 23, the plate member 1350 of the present embodiment includes a pairof outer arms or extensions 1370 a, 1370 b and a pair of inner arms orextensions 1375 a, 1375 b connected by a bridge member 1388. The innerextensions 1375 a, 1375 b and bridge member 1388 are configured to beenclosed by the body of the spacer 1310. Advantageously, the bridgemember 1388 helps provide added stability to the plate system 1305, andalso helps provide a barrier to retain graft material within the platesystem 1305.

In some embodiments, the spacer 1310 is formed of three differentmembers 1310 a, 1310, 1310 c. The members 1310 a and 1310 can be outermembers which bound the inner member 1310 c. As shown in FIG. 24C, themembers 1310 a and 1310 b can be substantially similar, and can includeupper and lower surfaces with surface protrusions to enable bettergripping of bone. Inner member 1310 c can be different from the othermembers and can include a relatively smooth surface without surfaceprotrusions. In addition, the inner member 1310 c can be of a differentheight than the other members. In some embodiments, the three members1310 a, 1310 b, 1310 c are pinned together, while in other embodiments,they can be joined together via an adhesive or mateable connection.Advantageously, the addition of the inner member 1310 c provides furthersupport to the overall structure of the plate system 1305.

FIGS. 25A and 25B illustrate another alternative low profile plateattached to a multi piece spacer having a metal insert according to someembodiments. The plate system 1405 comprises a plate member 1450attached to a multi-piece spacer 1410 formed of two similar components1410 a, 1410 b and a metal insert 1439. The plate member 1450 caninclude a first screw opening, a second screw opening and a rotatablelocking mechanism 1456 to prevent back out of screws that are insertedthrough the openings In some embodiments, the plate member 1450 of thepresent embodiment is mounted to the front of the spacer. In otherembodiments, the plate member 1450 includes a pair of outer arms orextensions and/or a pair of inner arms or extensions (not shown to helpretain the spacer 1410 within the plate member 1450.

In some embodiments, the spacer 1410 is formed of two members 1410 a and1410 b separated by a metal insert 1439. These members partially enclosea graft opening 1420. The two members 1410 a and 1410 b can be formed ofa material different from the metal insert 1439, such as PEEK.Advantageously, the metal insert 1439 is designed to provide additionalstrength to the spacer 1410. In some embodiments, the metal insert 1439is formed of titanium. As shown in the exploded view in FIG. 25B, thespacer 1410 be attached to the plate member 1450 via vertical fasteningmembers 1429 a, 1429 b. One skilled in the art will appreciate that thespacer 1410 can be used with any of the other plate members discussedabove.

FIGS. 26A-26D illustrate another alternative plate having raised andlowered screw openings in attachment with a spacer according to someembodiments. The plate 1550 and spacer 1510 have many similar featuresas in prior embodiments; however, the upper screw hole 1552 in the plate1550 has been raised, while the lower screw hole 1554 in the plate 1550has been lowered. The upper screw hole 1552 has been raised such that acenter axis of the upper screw hole 1552 is positioned entirely above anupper surface 1512 of the spacer 1510. The lower screw hole 1554 hasbeen lowered such that a center axis of the lower screw hole 1554 ispositioned entirely below a lower surface 1514 of the spacer 1510.Advantageously, by raising the upper screw hole 1552 such that a centeraxis extends completely above the upper surface 1512 of the spacer 1510,this provides a plate member 1550 having increased visibility on itsupper end and also provides an upper plate portion that can be uniquelypositioned relative to a disc space, as shown in FIG. 28. Likewise, bylowering the lower screw hole 1554 such that a center axis extendscompletely below the lower surface 1514 of the spacer 1510, thisprovides a plate member 1550 having increased visibility on its lowerend and also provides a lower plate portion that can be uniquelypositioned relative to a disc space, as also shown in FIG. 28.

In some embodiments, the plate 1550 and the spacer 1510 have manysimilar features as in prior embodiments. For example, the spacer 1510is configured to have a body having an upper surface 1512 in contactwith an upper vertebral body and a lower surface 1514 in contact with alower vertebral body. The spacer body includes notches for receivingportions of the plate 1550 therein. In some embodiments, the spacer 1510is formed of a natural material, such as allograft bone.

The plate 1550 includes the upper screw hole 1552 and the lower screwhole 1554, and a pair of arms or extensions that are designed to bereceived within the spacer 1510. As noted above, the upper screw hole1552 has been raised such that a center axis that extends through theupper screw hole 1552 is positioned higher than an upper surface of thespacer 1510. In some embodiments, only a portion of the center axisthrough the upper screw hole 1552 is positioned higher than an uppersurface of the spacer 1510, while in other embodiments, the entirecenter axis through the upper screw hole 1552 is positioned higher thanan upper surface of the spacer 1510. Likewise, the lower screw hole 1554has been lowered such that a center axis that extends through the lowerscrew hole 1554 is positioned lower than a lower surface of the spacer1510. In some embodiments, only a portion of the center axis that passesthrough the lower screw hole 1554 is positioned lower than a lowersurface of the spacer 1510, while in other embodiments, the entirecenter axis through the lower screw hole 1552 is positioned lower than alower surface of the spacer 1510.

In some embodiments, the plate 1550 includes an upper extension, eyelidor rim 1571 through which the upper screw hole 1552 can pass through. Insome embodiments, the upper rim 1571 has an anterior or front face 1553and a posterior or back face 1555 (identified in FIG. 26C). In someembodiments, both the front face 1553 and the rear face 1555 of theupper rim 1571 are straight and vertical and not angled relative toheight of vertical axis of the spacer. In other embodiments, either thefront face 1553 or the rear face 1555 can be straight, while the otherface can be angled (e.g., in an anterior direction). In yet otherembodiments, both the front face 1553 and the rear face 1555 of theupper rim 1571 can be angled. Advantageously, in some embodiments, theupper screw hole 1552 extends through the tipper rim 1571 at an anglesuch that a screw that is inserted through the upper screw hole 1552will be inserted at or near a corner edge of an upper vertebral body (asshown in FIG. 28). By being positioned at or near a corner edge of theupper vertebral body, it is not necessary for the screw to be positionedthrough an anterior face or aspect of the upper vertebral body, therebymaintaining a low profile implant. In some embodiments, the majority orentirety of the upper rim 1571 including the upper screw hole 1552 canbe configured such that the upper portion of the plate rests at or neara corner edge of the upper vertebral body, thereby maintaining a lowprofile implant.

In some embodiments, the plate 1550 includes a lower extension, eyelidor rim 1573 through which the lower screw hole 1554 can pass through. Insome embodiments, the lower rim 1573 has an anterior or front face 1553and a posterior or back face 1555 (identified in FIG. 29A). In someembodiments, both the front face 1553 and the rear face 1555 of thelower rim 1573 are straight and vertical and not angled relative toheight of vertical axis of the spacer. In other embodiments, either thefront face 1553 or the rear face 1555 can be straight, while the otherface can be angled (e.g., in an anterior direction). In yet otherembodiments, both the front face 1553 and the rear face 1555 of thelower rim 1573 can be angled. Advantageously, in some embodiments, thelower screw hole 1554 extends through the lower rim 1573 at an anglesuch that a screw that is inserted through the lower screw hole 1554will be inserted at or near a corner edge of a lower vertebral body (asshown in FIG. 28). By being positioned at or near a corner edge of thelower vertebral body, it is not necessary for the screw to be positionedthrough an anterior face or aspect of the upper vertebral body, therebymaintaining a low profile implant. In some embodiments, the majority orentirely of the lower rim 1573 including the lower screw hole 1554 canbe configured such that the lower portion of the plate rests at or neara corner edge of the lower vertebral body, thereby maintaining a lowprofile implant. Advantageously, in some embodiments, at least a portionof the upper rim 1571 and/or a portion of the lower rim 1573 ismaintained within the disc space between the upper vertebral body andthe lower vertebral body, thereby maintaining an implant with a lowprofile.

FIGS. 27A-27D illustrate another alternative plate having raised andlowered screw openings in attachment with a spacer according to someembodiments. The plate 1550 and the spacer 1610 are similar to theassembly in FIGS. 26A-26D, except the spacer 1610 is formed of adifferent material, such as PEEK. Advantageously, the plate 1550 iscapable of being assembled with either the bone spacer 1510 shown inFIGS. 26A-26D or the PEEK spacer 1610 shown in FIGS. 27A-27D prior toinsertion into a disc space, thereby providing versatility to a surgeon.

FIG. 28 illustrates the plate and spacer in FIGS. 26A-26D in use withina vertebral space. From this view, one can see how the plate 1510 isdesigned to have an upper rim 1571 that accommodates an upper screw hole1552 and a lower rim 1573 that accommodates a lower screw hole 1554. Theupper screw hole 1552 receives an upwardly angled screw that isconfigured to be inserted at or near a corner of the upper vertebralbody, thereby avoiding insertion through an anterior face or aspect ofthe upper vertebral body. The lower screw hole 1554 receives adownwardly angled screw that is configured to be inserted at or near acorner of the lower vertebral body, thereby avoiding insertion though ananterior face or aspect of the lower vertebral body.

FIGS. 29A-29C illustrate the plate in FIGS. 26A-26D without a spacer. Asshown in these figures, the plate 1550 includes an upper rim 1571 thataccommodates an upwardly angled screw hole 1552 and a lower rim 1573that accommodates a downwardly angled screw hole 1554. The upper rim1571 includes a front or anterior face 1553 a and a rear or posteriorface 1555 a, while the lower rim 1573 includes a front or anterior face1553 b and a rear or posterior face 1555 b. As shown in FIG. 29B, insome embodiments, the entire anterior face of the plate including theupper anterior face of the upper rim 1571 and the lower anterior face ofthe lower rim 1573) can be straight and non-angled. In otherembodiments, portions of the anterior face can be slightly angled, suchas in an anterior direction. In addition, as shown in FIG. 29B, in someembodiments, portions of the posterior faces of the plate (e.g.,posterior faces 1555 a and 1555 b) can also be straight and non-angled.In other embodiments, portions of the posterior faces can be angled(e.g., in an anterior direction), such as 5 degrees, 10 degrees, 15degrees, or more. In some embodiments, the anterior and/or posteriorfaces of the rims can be angled between 5 and 15 degrees.

FIG. 30 illustrates one example of an allograft spacer 1510 that can beused with the plate in FIGS. 26A-26D. FIG. 31 illustrates on example ofa PEEK spacer 1610 that can be used with the same plate. As noted above,the surgeon can desirably choose which spacer to insert into a surgicalsite.

One skilled in the art will appreciate that any of the plate systemsdescribed above can be used with other spinal implants. Among the otherimplants that can accompany the plate systems include stabilizationsystems and rod systems, including rod members, hook members, and bonefasteners such as pedicle screws. One skilled in the art will appreciatethat any of the plate systems described above can also be used with oneanother, or can be used multiple times along different segments of thespine. In addition, any of the plate systems described above can be usedwith a variety of navigation and guidance tools, including those relatedto neuromonitoring and robotics. Furthermore, one of skill in the artwill appreciate that the plate systems described above can be producedin a number of different ways, including in part via 3-D printingmethods.

It will be apparent to those skilled in the art that variousmodifications and variations can be made in the present inventionwithout departing from the scope or spirit of the invention. Moreover,the improved plate systems and bone screw assemblies and related methodsof use need not feature all of the objects, advantages, features andaspects discussed above. Thus, for example, those skilled in the artwill recognize that the invention can be embodied or carried out in amanner that achieves or optimizes one advantage or a group of advantagesas taught herein without necessarily achieving other objects oradvantages as may be taught or suggested herein. In addition, while anumber of variations of the invention have been shown and described indetail, other modifications and methods of use, which are within thescope of this invention, will be readily apparent to those of skill inthe art based upon this disclosure. It is contemplated that variouscombinations or subcombinations of these specific features and aspectsof embodiments may be made and still fall within the scope of theinvention. Accordingly, it should be understood that various featuresand aspects of the disclosed embodiments can be combined with orsubstituted for one another in order to form varying modes of thediscussed bone screw assemblies. Thus, it is intended that the presentinvention cover the modifications and variations of this inventionprovided that they come within the scope of the appended claims or theirequivalents.

What is claimed is:
 1. A spinal system comprising: a plate membercomprising a body having an anterior face, a posterior face, a firstlateral side comprising a first side arm and a second lateral sidecomprising a second side arm, the first and second side arms eachincluding a window that extends along a length of the first and secondside arms, respectively, an upper rim extending from the body and alower rim extending from the body, wherein the upper rim includes anupper screw hole extending through the upper rim and the lower rimincludes a lower screw hole extending through the lower rim, wherein theupper screw hole includes a first central axis that passes therethroughand the lower screw hole includes a second central axis that passestherethrough, wherein the upper screw hole is angled in an upwarddirection through the upper rim and the lower screw hole is angled in alower direction through the lower rim, wherein a height of each windowis greater than a length of each window; a first screw insertablethrough the upper screw hole, wherein the first screw is oriented in anupward direction, wherein the upper screw hole has an opening at theanterior face of the plate member; a second screw insertable through thelower screw hole, wherein the second screw is oriented in a downwarddirection, wherein the lower screw hole has an opening at the anteriorface of the plate member; and a spacer attachable to the plate memberadjacent the posterior face, wherein the spacer comprises an uppersurface, a lower surface, a first lateral surface, and a second lateralsurface, wherein each of the upper surface and the lower surfaceincludes one or more surface features thereon for engaging bone, whereinthe spacer further comprises a first vertical notch that extends fromthe upper surface to the lower surface of the spacer and a secondvertical notch that extends from the upper surface to the lower surfaceof the spacer, wherein the first vertical notch receives a portion ofthe first side arm of the plate member and the second vertical notchreceives a portion of the second side arm of the plate member, the firstand second lateral surfaces each having a portion extending laterallyoutward and into the respective windows of the first and second sidearms, wherein the spacer includes a longitudinal axis that extendsvertically from the upper surface of the spacer to the lower surface ofthe spacer, wherein the first central axis of the upper screw hole atthe point of the opening at the anterior face of the plate member ispositioned above the upper surface of the spacer, and the second centralaxis of the lower screw hole at the point of the opening at the anteriorface of the plate member is positioned below the lower surface of thespacer.
 2. The spinal system of claim 1, wherein the upper rim of theplate member includes an anterior face and a posterior face, whereineach of the anterior face and the posterior face are straight andnon-angled.
 3. The spinal system of claim 1, wherein the upper rim ofthe plate member includes an anterior face and a posterior face, whereinat least one of the anterior face and the posterior face are angled. 4.The spinal system of claim 3, wherein the posterior face of the upperrim is angled between 5 and 15 degrees in an anterior direction relativeto the longitudinal axis that extends vertically from the upper surfaceof the spacer to the lower surface of the spacer.
 5. The spinal systemof claim 1, wherein the plate member includes a rotatable lockingmechanism having portions to engage the first screw and the second screwto prevent backout of the first screw and the second screw from theplate member.
 6. The spinal system of claim 1, wherein the plate memberincludes a knife-like edge for inserting partially into a disc space. 7.The spinal system of claim 1, wherein the spacer comprises a naturalmaterial.
 8. The spinal system of claim 1, wherein the spacer comprisesa synthetic material.
 9. The spinal system of claim 1, wherein thespacer further comprises an upper chamfer and a lower chamfer, whereinthe upper chamfer is configured to accommodate the first screw and thelower chamfer is configured to accommodate the second screw.
 10. Aspinal system comprising: a plate member comprising a body having ananterior face, a posterior face, a first lateral side comprising a firstside arm and a second lateral side comprising a second side arm, thefirst and second side arms each including a window that extends along alength of the first and second side arms, respectively, an upper rimextending from the body and a lower rim extending from the body, whereinthe upper rim includes an upper screw hole extending through the upperrim and the lower rim includes a lower screw hole extending through thelower rim, wherein the upper screw hole includes a first central axisthat passes therethrough and the lower screw hole includes a secondcentral axis that passes therethrough, wherein the upper screw hole isangled in an upward direction through the upper rim and the lower screwhole is angled in a lower direction through the lower rim, wherein theplate member further includes a rotatable blocking mechanism positionedbetween the upper screw hole and the lower screw hole, wherein a heightof each window is greater than a length of each window; a first screwinsertable through the upper screw hole, wherein the first screw isoriented in an upward direction, wherein the upper screw hole has anopening at the anterior face of the plate member; a second screwinsertable through the lower screw hole, wherein the second screw isoriented in a downward direction, wherein the lower screw hole has anopening at the anterior face of the plate member; and a spacerattachable to the plate member adjacent the posterior face, wherein thespacer comprises an upper surface, a lower surface, a first lateralsurface, and a second lateral surface, wherein the spacer furthercomprises a first vertical notch that extends from the upper surface tothe lower surface of the spacer and a second vertical notch that extendsfrom the upper surface to the lower surface of the spacer, wherein thefirst vertical notch receives a portion of the first side arm of theplate member and the second vertical notch receives a portion of thesecond side arm of the plate member, the first and second lateralsurfaces each having a portion extending laterally outward and into therespective windows of the first and second side arms, wherein the spacerincludes a longitudinal axis that extends vertically from the uppersurface of the spacer to the lower surface of the spacer, wherein thefirst central axis of the upper screw hole at the point of the openingat the anterior face of the plate member is positioned above the uppersurface of the spacer, and the second central axis of the lower screwhole at the point of the opening at the anterior face of the platemember is positioned below the lower surface of the spacer, wherein theplate member includes no further screw holes than the upper screw holeand the lower screw hole for receiving a screw that engages an adjacentvertebra.
 11. The spinal system of claim 10, wherein the spacercomprises a C-shaped opening for receiving graft material therein. 12.The spinal system of claim 10, wherein the spacer comprises a taperedupper surface and a tapered lowered surface.
 13. The spinal system ofclaim 10, wherein the spacer is formed of allograft or PEEK.
 14. Thespinal system of claim 10, wherein the portions of the first and secondlateral surfaces extending laterally outward include a first bump outportion and a second bump out portion, respectively, wherein the firstbump out portion is securable to the first side arm of the plate memberand the second bump out portion is securable to the second side arm ofthe plate member.
 15. The spinal system of claim 10, wherein the platemember includes a first knife-like edge that extends upwardly and asecond knife-like edge that extends downwardly.
 16. The spinal system ofclaim 10, wherein the upper rim has a front surface and a back surface,wherein at least one of the front surface and the back surface is angledin an anterior direction.
 17. The spinal system of claim 16, whereinboth the front surface and the back surface of the upper rim are angledin an anterior direction.
 18. The spinal system of claim 10, wherein theupper rim has a front surface and a back surface, wherein both the frontsurface and the back surface are non-angled.
 19. The spinal system ofclaim 10, wherein the plate member is removably attachable from thespacer.